Putting PAMA cuts off another year is big news, yet the anxiety increases each year that goes by because the cuts loom ever worse.
Andi Brooks (APS Medical Billing): They put it off a year, but that’s it—a reprieve in the cuts for 2026. They changed the reporting year requirement, but we now have to report 2025 data in 2026. We wanted to reduce the cuts to a maximum of five percent per year; it’s still 15 percent. National labs will report all their information, but we need to be sure all labs are represented—independent labs, physician office labs, all the other labs that have the more sustainable rates. We do not have the much-needed relief or a fix, like we saw in the SALSA or RESULTS acts.
Dr. Cardona, can you discuss the victory of deferring PAMA cuts for a year and the potentially big problem we’ll be talking about a year from now?
Dr. Cardona (Wake Forest): With the latest legislation that passed we did get a little reprieve, but we still have to report this year. At least it’s more relevant data. The reporting piece alone is burdensome. They included more labs than just the large reference labs. The American Hospital Association is getting involved from an advocacy perspective; it was somewhat silent on the first go-around. It is important to have its voice on the impact this will have on health care systems and hospitals.
The big push now is the RESULTS Act. It is essential to reform PAMA, reset everything using data that’s not self-reported but is publicly available and felt to be trusted, and put limits on maximum reductions year over year to allow for a cushion.
Dr. Tuthill, can you imagine anything other than a rewrite of the No Surprises Act that would satisfy anyone?
Dr. Tuthill (Henry Ford): No. We’re trying to put a Band-Aid on a global problem and it needs to be addressed holistically, which we’ve never been able to do. We’ve been clawing to stay on the edge of the cliff.
In terms of the network question, we’re in a unique situation because we had a closed network so we’ve expanded our own. We have more opportunities to use more payers, and because of our size we’ve become a preferred agency for testing. We run into carveouts when we bump into things like workman’s compensation or organizations that have rules for where lab testing should go. It starts to get complex when you get into provider-based billing. It becomes a complicated onion and we keep going to the next layer.
Without a completely different perspective on this, it doesn’t satisfy anyone. Pay for performance is supposed to take care of this problem. In theory, it will be a master bill for all. I have yet to see that coming into actuality, and I don’t know if it helps or hurts us. It may be worse than PAMA cuts.
Jessica Forgette-Gedeon, can you comment on pay for performance?
Jessica Forgette-Gedeon (APS Medical Billing): Pay for performance supports value-based care by focusing on quality outcomes rather than volume, which can improve patient-centered care and help reduce costs. Unlike fee-for-service models that may incentivize higher volumes, this approach rewards providers for better outcomes, such as improved recovery and fewer readmissions. As the number of patients with more complex and severe health conditions continues to rise, there is a greater need for enhanced health outcomes. However, like PAMA, it requires significant data collection and reporting, which can add administrative burden. We may continue to see a hybrid model that balances quality and volume.
Mike Fauver, what are you seeing at XiFin about reporting?
Mike Fauver (XiFin): While we are supporting our customers to comply with the 2026 PAMA reporting requirements, I agree we need broader PAMA reform that caps reimbursement cuts. We are collaborating with associations to advocate for the passage of the RESULTS Act and encouraging our customers to do the same.
It is important that our customers have clean and accurate data not only to meet PAMA reporting requirements but also to better understand their business. Cuts are coming, and having the right data to understand your laboratory and pathology operations and financial impacts puts you in a better position to make strategic business decisions.